Impact of Obesity and Diabetes on Bone Health in Adolescents: New Findings from ENDO 2025
SAN FRANCISCO — Research presented at the ENDO 2025 conference indicates a concerning trend regarding the impact of childhood obesity and type 2 diabetes on bone health. The study suggests that adolescents diagnosed with obesity or impaired glucose tolerance (IGT) exhibit lower bone mineral density (BMD) in key areas such as the tibia, raising concerns about the potential for increased fracture risk in adulthood.
Dr. Fida Bacha, a pediatric endocrinologist from the Baylor College of Medicine, articulated key findings during her presentation. She noted that while adults with obesity and type 2 diabetes typically have normal or elevated BMD, the long-term implications of bone structure alterations emerging during adolescence could predispose them to fractures later in life. “Youth with obesity and type 2 diabetes may experience compromised bone accrual over time, which poses risks as they transition into adulthood,” Bacha emphasized.
The longitudinal study involved 48 adolescents aged approximately 15.5 years, all in Tanner stages 2-4 of development. Among the cohort, 27% were classified with normal weight, 31% had overweight alongside normal glucose tolerance, and 42% had overweight with IGT, including diagnoses of prediabetes or type 2 diabetes. Researchers measured various health factors, including body composition, cardiorespiratory fitness, and glycemic profiles, at multiple points—baseline, six months, and one year—at both the distal tibia and radius using high-resolution peripheral quantitative computed tomography.
At baseline, vitamin D levels were notably lower among youths exhibiting impaired glucose tolerance, clocking in at 14.9 ng/mL compared to higher levels in their normal-weight peers (32.1 ng/mL). Significantly, insulin resistance demonstrated a negative correlation with total volumetric BMD at both the tibia and radius. One year later, adolescents with overweight and IGT continued to show lower volumetric BMD when compared with their normal-weight counterparts.
These findings further reveal that normal-weight adolescents demonstrate higher levels of procollagen type 1 N-terminal propeptide (P1NP) and osteocalcin—biomarkers indicating bone formation—compared to youths with obesity or IGT. Increased P1NP levels correlated positively with improvements in BMD over the study duration.
Dr. Bacha called for larger studies encompassing a more diverse range of glycemic levels to validate these findings and further investigate the relationship between metabolic health and skeletal formation in children. The outcomes of this research underline the urgent need for preventive strategies addressing childhood obesity and diabetes to safeguard long-term bone health, emphasizing the importance of a comprehensive approach to health management in adolescents.
This research contributes to a growing body of literature linking metabolic disorders with skeletal deficiencies, and it highlights the critical window of adolescence as a period for establishing healthy bone density, crucial for preventing osteoporosis and related fractures in later life.
